A lack of understanding of primary care practice has limited previous efforts to enhance delivery of cancer early detection and prevention services. As an NCI-funded independent investigator, the applicant has developed innovative new approaches to understanding and enhancing cancer prevention and control in community primary care practice. Moreover, an Associate Director for Prevention, Control and Population Research at an NCI-designated Comprehensive Cancer Center, and as a director of one of 3 newly-funded family practice research centers, he has established mentoring relationships with junior investigators studying patient-oriented approaches to advancing the cancer prevention and control effectiveness of primary care practice. The proposed Midcareer Investigator Award in Patient-Oriented Research will use a multi-method research approach to advance cancer prevention and control in community primary care practice in 4 ways: 1) Expanded analysis of a rich existing dataset generated from the NCI-funded Direct Observation of Primary Care Practice (DOPC) Study, guided by a new theoretical model, will provide insights into previously unanticipated factors affecting cancer preventive service delivery in real world practice. 2) Collection and analysis of new data on high performing practices in the ongoing Study to Enhance Prevention by Understanding Practice (STEP- UP) will identify will identify practices' values, structures and processes that affect response to a prevention intervention. 3) These new data collection and analyses will be used to identify new intervention approaches to increase cancer investigators to develop innovative new interventions that integrate patient-oriented cancer screening, health habit counseling, familial risk identification and selective cancer genetic screening, and integration of population and clinical approaches to cancer prevention and early detection in primary care practice. This proposal builds on a strong set of ongoing investigations and investigators to create a critical mass of patient-oriented researchers. The innovative insights that are likely to spring from this initiative will advance the knowledge base for achieving the vas potential of primary care practice for cancer prevention and control.